Tag: Medicare Administrative Contractor (MAC)
OIG: MACs miss mark on cost reports
March 20, 2025HME News Staff
WASHINGTON – Medicare Administrative Contractors did not consistently meet Medicare cost report oversight requirements, according to a new report from the Office of Inspector General.
For federal fiscal years 2019–2021, each of the 12 MAC jurisdictions failed to comply with the contract requirements for audit and reimbursement desk review and audit quality (AR-4) for at least one of the three years.
CMS identified 287 total audit issues among all MAC jurisdictions during...
CMS proposes MAC changes
September 9, 2024HME News Staff
WASHINGTON – CMS has posted a request for information to obtain public feedback on consolidating the Medicare Administrative Contractor (MAC) jurisdictions. The RFI also asks for feedback on awarding future MAC contracts with 10-year award periods of performance. The agency asks that those interested submit responses by email to MAC_Procurement@cms.hhs.gov within 30 days of the RFI publication date (Sept. 4). It says responses should be submitted as an email attachment in Microsoft Word and...
Senators introduce bill to change LCD process
October 5, 2016HME News Staff
WASHINGTON - Two senators recently introduced a bill that seeks to improve the transparency and accountability of the local coverage determination (LCD) process performed by the Medicare Administrative Contractors (MACs).
The Local Coverage Determination Clarification Act of 2016 would: require open and public meetings with the MACs that are on the record; require disclosure by the MACs of the rationale for an LCD and the evidence for that decision at the beginning of the process; provide stakeholders...
CMS limits scope of audits
September 1, 2015HME News Staff
WASHINGTON - For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article.
In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item.
“In some cases, where the original denial reason is cured,...
In brief: MACs miss standards, health spending stays low
January 10, 2014HME News Staff
BALTIMORE - Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS's performance standards, according to a new report from the Office of Inspector General (OIG). “Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states. The OIG based its findings on a performance...
MACs miss performance standards, OIG finds
January 10, 2014HME News Staff
BATLIMORE - Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS's performance standards, according to a new report from the Office of Inspector General (OIG).
“Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states.
The OIG based its findings on...
Noridian reports overpayments on PMD rentals
August 22, 2013HME News Staff
FARGO, N.D. - Noridian Administrative Services has reported overpayments on some power mobility devices in Round 2 competitive bidding areas. Noridian says the problem stems from a system issue that led to DME MACs paying a higher rate than allowed under the program. Claims that meet the following criteria have been overpaid: processed on or after July 1, 2013, billed with the KJ modifier and submitted under a certain code (for a list of the codes, go here). Noridian says it will adjust these claims...
MACs join forces to reduce denials
July 30, 2013HME News Staff
WASHINGTON - The Part A and Part B Medicare Administrative Contractors have formed a task force to educate on national issues of concern regarding improper payment errors, they have announced. The Comprehensive Error Rate Testing (CERT) A/B Contractor Task Force will hold its first teleconference Aug. 20. The task force affords providers the benefit of a “collaborative, consistent voice to reduce costly claim denials, as well as the CERT error rate,” according to a bulletin. The task...